Burleigh Manor Middle School

BURLEIGH MANOR MIDDLE SCHOOL 4200 Centennial Lane • Ellicott City, MD 21042 Antoinette Roberson Kimberly Scaife Principal Assistant Principal

AFTER-SCHOOL ACTIVITY PERMISSION SLIP

The following after-school activity is being held at Burleigh Manor Middle School. Students may only participate if they have turned in this permission slip signed by parent/guardian and have prearranged for a ride. Any change in the following schedule will be announced in advance. Cancellations will only occur due to inclement weather or emergencies. Because of this possibility please make sure your child knows what plans he/she should follow to get home before this situation should occur. On days your child is unable to attend, he/she should provide a note or email to Mrs. Randolph. Students will need to dress appropriately. All students are expected to follow school policies and procedures.

Students are expected to bring this permission slip back to the Mrs. Randolph as soon as possible. This activity is limited to the first 30 girls who sign up! No requests to call for permission over the telephone will be granted. If a child forgets to bring in a signed permission slip before 8:00 AM, he/she must take his/her regular transportation home on that day.

Please keep this part of the permission slip in a safe place so you and your child will know which days he/she will be at school and will need a ride home.

After-School Activity: Girls Breaking Barriers weSTEM Day of the week program will take place: Wednesday Dates: 2/15, 2/22, 3/1, 3/8, 3/15, 3/22, 3/29, 4/5/4/19, 4/26, 5/3, 5/10, 5/17, 5/24, 5/31 Beginning Time: 2:45 Ending Time: 3:45 If picking up your child, please arrive promptly @ 3:45 to the CHS side of the building. Sincerely,

Barbara Randolph Sponsor

------This form must be turned in by 8:00 AM February 14t Permission for After-School Activity

Student Name: Activity/Teacher: Dates Wednesdays until 5/31 Time of Activity: 2:45 Pick up time: 3:45 I will pick up my child at . My child has my permission to walk home. Parent Name: Parent Signature: Home Phone Number: Work Phone Number: E-mail Address: Emergency person and phone number: No medications will be dispensed after the school day ends at 2:45 PM. In the event of a medical emergency, 911 will be called.